Greenport doctor Frank Adipietro injects surgical cement into the damaged vertebrae of an 87-year-old woman suffering from chronic back pain for years. The procedure, called kyphoplasty, was recently criticized by the New England Journal of Medicine.
A few weeks ago, Marian Geoghan’s back started killing her.
The 87-year-old resident of Peconic Landing in Greenport said she’d suffered from back pain on and off for years, but only recently did it take a turn for the worse. She wasn’t sure what was causing it, but she knew she didn’t want to go through any major surgery.
She also didn’t want to take measures such as massage or acupuncture that could be too conservative to ease her chronic pain. Ms. Geoghan said she had learned that lesson about three years ago, when she let a fractured rib heal on its own.
“I was laid up for three months in the summertime,” she said. “There wasn’t much I could do for it other than painkillers and rest.”
Her solution this time around was to see Dr. Frank Adipietro, interventional pain management specialist at Eastern Long Island Hospital in Greenport. He recommended that Ms. Geoghan go through a minimally invasive surgical procedure for spinal bone fractures called balloon kyphoplasty.
“This lady has a history of compression fractures,” he said before the surgery last Friday. “Right now, she has one that has been troubling her for weeks, and it’s been very painful.”
‘We can take a patient who has been in complete pain and get her right back on her feet.’ Dr. Frank Adipietro, Eastern Long Island HospitalOsteoporosis causes more than 700,000 spinal fractures each year in the U.S., more than twice the annual number of hip fractures, according to the National Osteoporosis Foundation. Because of the complexity of back pain, Dr. Adipietro added, about two-thirds of these fractures go undiagnosed or untreated. But once the correct diagnosis is made, kyphoplasty can take away back pain almost immediately, the doctor said.
“This is a situation where we can take a patient who has been in complete pain and get her right back on her feet within 24 hours and living a regular lifestyle, which is the whole key to these pain management procedures,” he said. Ms. Geoghan “has a new fracture which has not been healing on its own, in fact it’s getting worse. She’s the perfect candidate for this type of procedure.”
During the 20-minute surgery — which requires only a light sedative for the patient — cement is injected into the fractured bone through tiny tubes while balloons open up tiny cavities in the bone that the cement can go into safely, he said.
“With other techniques, where you don’t use a balloon, the cement spreads straight into the bone and can sometimes go in a haphazard way,” Dr. Adipietro said. “And what causes the pain is the microfractures of the bone. The cement takes about an hour to cure, then it stabilizes the fractures in the bone and the pain goes away.”
Patients who sign up for kyphoplasty range from the elderly to the “16-year-old cheerleader who herniated a disk to the long distance runner in his 20s to people in car accidents,” Dr. Adipietro said. “Anyone who needs pain management.”
Kyphoplasty — and a similar procedure called vertebroplasty, which is also offered at Eastern Long Island Hospital — recently came under fire from a clinical study published in the New England Journal of Medicine. The study found a lack of data to support the claim that the procedure will result in an “immediate and sustained reduction in pain.”
“Not only is the short-term efficacy of vertebroplasty unproven,” the Journal reported, “but there are also several uncontrolled studies suggesting that vertebroplasty may increase the risk of subsequent vertebral fractures, particularly in vertebrae that are adjacent to treated levels, and sometimes after cement has leaked into the adjacent disks.”
Dr. Adipietro called the study, which was reported in The New York Times, “unfortunate.”
“Here’s all these people with broken bones, and they don’t know what to do,” he said. “What can happen after the procedure is that the pain caused by the bone fracture goes away but different types of pain associated with standard back issues then begin to pop up. Researchers obviously picked this topic and said, ‘OK, does this work better than conservative measures?’ Well, those of us who do the procedure almost on a daily or weekly basis can tell you that we have patients out there that would be in chronic pain if this procedure were not done.”
Minimally invasive surgery is always better than the old methods of “opening the back up” to fix a fractured bone, Dr. Adipietro added.
“Sometimes people would be in body casts for three to six months,” he said.
In Dr. Adipietro’s view, having the procedure done when a person is already in chronic pain can’t hurt — because it isn’t going to get worse after the quick and simple operation, he said.
Two days after her operation, Ms. Geoghan said that she wasn’t quite comfortable yet but she wasn’t in as much pain as she had been three weeks before.
“It’s day by day,” she said. “Today is better than the day before. Hopefully by the end of the week I’ll feel much better.”
SOURCE: The Suffolk Times
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